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Wiese JL, Watson TM, Bozinoff N, Rush B, Stergiopoulos V, Le Foll B, Rueda S. "Like the Wild West": Health care provider perspectives on impacts of recreational cannabis legalization on patients and providers at a tertiary psychiatric hospital in Ontario, Canada. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 167:209487. [PMID: 39153735 DOI: 10.1016/j.josat.2024.209487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 07/18/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Legalization has increased cannabis availability in Canada. Research shows complex relationships between cannabis use and mental health, and a need for health care providers to engage with patients about cannabis use. Providers have noted gaps in knowledge and research on the medical effects of cannabis as barriers to service delivery. It is unclear how providers and patients in mental health care settings have been impacted by legalization. METHODS From June 1 to July 2, 2021, we conducted a qualitative study involving semi-structured interviews with 20 health care providers in a range of roles (e.g., physicians, pharmacists, nurses) within a psychiatric hospital setting. Participants responded to open-ended questions with follow-up probes on various topics related to cannabis legalization. Topics included impacts on patient mental and physical health, clinical impacts, education and training, legal cannabis retail system and the medical cannabis access system. RESULTS Thematic analysis identified several themes in the data. Participants reported that legalization has had some positive impacts relating to clinical care and cannabis safety. They also expressed concerns with increased rates of cannabis use, risks to mental health and ongoing challenges engaging with patients about cannabis. Participants made recommendations for medical educators and regulators (e.g., updated curriculums, clinical guidelines), the mental health care sector (e.g., implementation of standardized screening), government (e.g., public health campaigns, safe use guidelines), the medical cannabis access system (e.g., increased regulation, research), and the legal cannabis system (e.g., zoning changes, point-of-sale information). CONCLUSIONS This study begins to address the paucity of data on impacts of legalization from mental health service delivery settings. Findings show that although legalization has had some positive impacts, there are ongoing patient concerns and unmet provider needs. More research is needed to understand the experiences of providers delivering care to populations experiencing mental health and/or substance use concerns who use cannabis in the post-legalization era.
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Affiliation(s)
- Jessica L Wiese
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada.
| | - Tara Marie Watson
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada.
| | - Nikki Bozinoff
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Addictions Division, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON M6J 1H4, Canada.
| | - Brian Rush
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Homewood Research Institute, 150 Delhi Street, Guelph, ON N1E 6K9, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada.
| | - Vicky Stergiopoulos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Centre for Addiction and Mental Health, 1000 Queen Street West, Toronto, ON M6J 1H4, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada; Acute Care Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON M6J 1H1, Canada.
| | - Bernard Le Foll
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada; Acute Care Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON M6J 1H1, Canada; Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; Institute of Medical Sciences, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada.
| | - Sergio Rueda
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada; Institute of Medical Sciences, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON M5T 3M6, Canada.
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Fischer B, Robinson T. Should cannabis self-cultivation be part of a public health‒oriented legalization policy framework? CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024:10.17269/s41997-024-00914-5. [PMID: 39048848 DOI: 10.17269/s41997-024-00914-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/14/2024] [Indexed: 07/27/2024]
Abstract
Cannabis control policies are increasingly being liberalized, including the legalization of non-medical cannabis use and supply in multiple settings, for example in Canada, with main policy objectives focusing on improved public health. An important while contested matter has been the appropriate design of legal cannabis supply structures and sources. These, in most Americas-based legalization settings, have included provisions for (limited) 'home cultivation'. Recent data suggest that about 8% of active consumers engage in cannabis home cultivation for their own supply, while approximately 14% are exposed to it in/around their home. Home cultivation commonly exceeds legal limits and/or occurs where not allowed, and is disproportionately associated with high-frequency and/or other risk patterns of cannabis use. In addition, home cultivation may facilitate exposure or diversion of cannabis to minors, as well as pose possible environmental exposure risks especially when occurring indoors. Given its placement in private spaces, related regulations are largely shielded from enforcement. Home cultivation, therefore, bears substantive potential to circumvent or work counter to public health‒oriented legalization policy objectives. Recent assessments of health outcomes from cannabis legalization show mixed-including multiple adverse-results, implying the need for regulatory revisions towards protecting public health outcomes. Especially in settings where extensive (e.g. commercial) retail systems were established to provide regulated, legal cannabis products to consumers, it is questionable whether home cultivation overall serves primary public health‒oriented objectives; relevant data should be expanded and used to review related provisions.
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Affiliation(s)
- Benedikt Fischer
- Centre for Applied Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.
- Research & Graduate Studies, University of the Fraser Valley, Abbotsford, BC, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Canada School of Population Health, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil.
| | - Tessa Robinson
- Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Lamy FR, Meemon N. Exploring Twitter chatter to assess the type and availability of cannabis-related products in Thailand. J Ethn Subst Abuse 2024:1-21. [PMID: 38949657 DOI: 10.1080/15332640.2024.2367253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Cannabis-related tweets were collected between January and April 2022 to estimate the availability and characteristics of cannabis products advertised on Twitter amid the legalization of recreational cannabis in Thailand. The Twitter API was called using the tweepy Python library to collect cannabis-related tweets in the Thai language. A total of 185,558 unique tweets were collected over the duration of the data collection period based on 83 search terms. Twenty thousand random tweets were manually coded by four Thai native speakers to assess the volume and characteristics of tweets proposing cannabis. 72.6% of collected tweets from the 20,000 random samples were coded as relevant to the study. 54.6% of relevant tweets were advertising cannabis products, 29.8% were personal communications, and 15.6% were related to news or media content. Among the tweets that advertised cannabis products, 94.4% proposed cannabis flower, 2.4% cannabis edibles and 1.8% cannabis concentrates. Consumption of potent forms of cannabis such as cannabis edibles and concentrates increase the risk of harmful side-effects, especially in a population with limited knowledge about these products. Our findings call for additional monitoring efforts and for increasing the public awareness on potent cannabis products emerging in Thailand.
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Affiliation(s)
- Francois R Lamy
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
- Health Solutions Research Unit, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
| | - Natthani Meemon
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
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Kourgiantakis T, Vicknarajah R, Logan J, Edwards T, Lee E, Craig S, Kaura A, Williams CC, Marshall S. Understanding youth and young adult cannabis use in Canada post-legalization: a scoping review on a public health issue. Subst Abuse Treat Prev Policy 2024; 19:30. [PMID: 38886804 PMCID: PMC11184772 DOI: 10.1186/s13011-024-00615-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Canada legalized recreational cannabis in 2018, and one of the primary objectives of the Cannabis Act was to protect youth by reducing their access to cannabis and providing public education. Canada has the highest prevalence of cannabis use worldwide, particularly among youth and young adults under the age of 25. Cannabis use is linked with many adverse effects for youth and young adults including psychosis, anxiety, depression, respiratory distress, cannabinoid hyperemesis syndrome, and impaired cognitive performance. Despite the high prevalence of cannabis use and the evolution of policies in Canada and globally, significant knowledge and research gaps remain regarding youth and young adult cannabis use. The aim of this scoping review is to map the extent, nature, and range of evidence available on youth and young adult cannabis use in Canada since its legalization, in order to strengthen policies, services, treatments, training, and public education strategies. METHODS Using a scoping review framework developed by Arksey and O'Malley, along with the PRISMA-ScR guidelines, we conducted a rigorous search in five academic databases: MEDLINE, Embase, APA PsycINFO, CINAHL and Web of Science Core Collection. We included empirical studies that collected data in Canada after the legalization of recreational cannabis (October 2018) and focused on youth or young adults < 30. Two reviewers independently screened articles in two stages and extracted relevant information from articles meeting the inclusion criteria. RESULTS Of the 47 articles meeting our inclusion criteria, 92% used quantitative methods, 6% were qualitative, and 2% used a mixed-methods approach. Over two-thirds (68%) used secondary data. These studies were categorized into six focus areas: (1) prevalence, patterns, and trends, (2) cannabis-related injuries and emergency department (ED) visits, (3) rates and patterns during the pandemic, (4) perceptions of cannabis use, (5) prevention tools, and (6) cannabis-related offenses. Key findings from the studies reviewed include an increase in cannabis use among 18-24-year-olds post-legalization, with mixed results for youth under 18. ED visits for intentional and unintentional cannabis-related injuries have increased in young children and teens. Perception studies show a mix of concern and normalization of cannabis use. Though limited, prevention studies are promising in raising awareness. A decline in cannabis-related offenses was noted by one study. The review highlights several research gaps, including the need for more qualitative data, disaggregation of demographic data, intervention research, and comprehensive studies on the physical and mental health impacts of cannabis use among youth and young adults. CONCLUSION Maintaining a public health approach is critical, with a focus on reducing the high prevalence of cannabis use among youth and young adults. This involves implementing prevention strategies to minimize harms, enhancing public education, minimizing commercialization, reducing youth access to cannabis, promoting guidelines for lower-risk cannabis use and harm reduction strategies, and increasing training for healthcare providers.
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Affiliation(s)
- Toula Kourgiantakis
- École de travail social et de criminologie, Université Laval, 1030, avenue des Sciences-Humaines, Pavillon Charles-De-Koninck (local 6489), Québec, QC, G1V 0A6, Canada.
| | - Ragave Vicknarajah
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Judith Logan
- John P. Robarts Library, University of Toronto, Toronto, ON, Canada
| | - Travonne Edwards
- School of Child and Youth Care, Toronto Metropolitan University, Toronto, ON, Canada
| | - Eunjung Lee
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Shelley Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Ashima Kaura
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Savannah Marshall
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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Di Ciano P, Wickens C, Paul EM, Mahmood R, Crépault JF, Rueda S, Boileau I. The Cannabis Act: implications for human participant research with cannabis. J Psychiatry Neurosci 2024; 49:E212-E217. [PMID: 38889952 PMCID: PMC11192575 DOI: 10.1503/jpn.240049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Affiliation(s)
- Patricia Di Ciano
- From the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont. (Di Ciano, Wickens, Paul, Rueda); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Boileau); the Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Crépault); the Campbell Family Mental Health Research Institute, Toronto, Ont. (Di Ciano, Wickens, Rueda, Boileau); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Rueda); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Wickens, Boileau); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Mahmood, Rueda, Boileau); the Addiction Imaging Research Group, Centre for Addiction and Mental Health, Toronto, Ont. (Mahmood, Boileau); the Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Boileau); Communications and Partnerships, Centre for Addiction and Mental Health, Toronto, Ont. (Crépault)
| | - Christine Wickens
- From the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont. (Di Ciano, Wickens, Paul, Rueda); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Boileau); the Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Crépault); the Campbell Family Mental Health Research Institute, Toronto, Ont. (Di Ciano, Wickens, Rueda, Boileau); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Rueda); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Wickens, Boileau); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Mahmood, Rueda, Boileau); the Addiction Imaging Research Group, Centre for Addiction and Mental Health, Toronto, Ont. (Mahmood, Boileau); the Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Boileau); Communications and Partnerships, Centre for Addiction and Mental Health, Toronto, Ont. (Crépault)
| | - Elvin M Paul
- From the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont. (Di Ciano, Wickens, Paul, Rueda); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Boileau); the Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Crépault); the Campbell Family Mental Health Research Institute, Toronto, Ont. (Di Ciano, Wickens, Rueda, Boileau); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Rueda); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Wickens, Boileau); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Mahmood, Rueda, Boileau); the Addiction Imaging Research Group, Centre for Addiction and Mental Health, Toronto, Ont. (Mahmood, Boileau); the Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Boileau); Communications and Partnerships, Centre for Addiction and Mental Health, Toronto, Ont. (Crépault)
| | - Raesham Mahmood
- From the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont. (Di Ciano, Wickens, Paul, Rueda); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Boileau); the Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Crépault); the Campbell Family Mental Health Research Institute, Toronto, Ont. (Di Ciano, Wickens, Rueda, Boileau); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Rueda); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Wickens, Boileau); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Mahmood, Rueda, Boileau); the Addiction Imaging Research Group, Centre for Addiction and Mental Health, Toronto, Ont. (Mahmood, Boileau); the Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Boileau); Communications and Partnerships, Centre for Addiction and Mental Health, Toronto, Ont. (Crépault)
| | - Jean-François Crépault
- From the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont. (Di Ciano, Wickens, Paul, Rueda); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Boileau); the Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Crépault); the Campbell Family Mental Health Research Institute, Toronto, Ont. (Di Ciano, Wickens, Rueda, Boileau); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Rueda); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Wickens, Boileau); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Mahmood, Rueda, Boileau); the Addiction Imaging Research Group, Centre for Addiction and Mental Health, Toronto, Ont. (Mahmood, Boileau); the Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Boileau); Communications and Partnerships, Centre for Addiction and Mental Health, Toronto, Ont. (Crépault)
| | - Sergio Rueda
- From the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont. (Di Ciano, Wickens, Paul, Rueda); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Boileau); the Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Crépault); the Campbell Family Mental Health Research Institute, Toronto, Ont. (Di Ciano, Wickens, Rueda, Boileau); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Rueda); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Wickens, Boileau); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Mahmood, Rueda, Boileau); the Addiction Imaging Research Group, Centre for Addiction and Mental Health, Toronto, Ont. (Mahmood, Boileau); the Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Boileau); Communications and Partnerships, Centre for Addiction and Mental Health, Toronto, Ont. (Crépault)
| | - Isabelle Boileau
- From the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont. (Di Ciano, Wickens, Paul, Rueda); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Boileau); the Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Crépault); the Campbell Family Mental Health Research Institute, Toronto, Ont. (Di Ciano, Wickens, Rueda, Boileau); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Rueda); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Wickens, Boileau); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Mahmood, Rueda, Boileau); the Addiction Imaging Research Group, Centre for Addiction and Mental Health, Toronto, Ont. (Mahmood, Boileau); the Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Boileau); Communications and Partnerships, Centre for Addiction and Mental Health, Toronto, Ont. (Crépault)
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Rubin-Kahana DS, Butler K, Hassan AN, Sanches M, Le Foll B. Cannabis Use Characteristics Associated with Self-Reported Cognitive Function in a Nationally Representative U.S. sample. Subst Use Misuse 2024; 59:1303-1312. [PMID: 38664196 DOI: 10.1080/10826084.2024.2340975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND With increases in cannabis use and potency, there is a need to improve our understanding of the impact of use on cognitive function. Previous research indicates long-term cannabis use may have a negative effect on executive function. Few studies have examined persistence of it in protracted abstinence, and there is limited evidence of predictors of worse cognitive function in current and former users. In this study, we aim to evaluate the associations between cannabis use status (current, former, and never use) and self-report cognition. Further, we investigate if cannabis use characteristics predict self-report cognitive function. METHODS Cross-sectional cannabis use data from the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III), a national survey (N = 36,309) conducted in the USA between 2012 and 2013 were used alongside the Executive Function Index scales. The data were analyzed by using Ordinary Least Squares regression. RESULTS Current (N = 3,681, Female = 37.7%) and former users (N = 7,448, Female = 45.4%) reported poorer cognition than never users (N = 24,956, Female = 56.6%). Self-reported cognition of former users was in-between that of current and never users. Several cannabis use characteristics were associated with self-reported cognition in current and former users. CONCLUSION While prospective studies are required to confirm, findings suggest cannabis use is linked to worse cognition. There may be some limited recovery of cognition in former users and some cannabis use characteristics predict impairment. These findings add to our understanding of the cognitive impact of cannabis use. As worse cognitive function may impact relapse, findings have implications for personalization of cannabis use disorder treatment.
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Affiliation(s)
- Dafna Sara Rubin-Kahana
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Butler
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- School of Psychology, College of Health and Science, University of Lincoln, Lincoln, UK
| | - Ahmed Nabeel Hassan
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, King Abdul-Aziz University, Jeddah, Saudi Arabia
- Department of Psychiatry, Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Marcos Sanches
- Biostatistics Core, Centre for Addiction and Mental Health, Centre for Addiction and Health, Toronto, Ontario, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Departments of Family and Community Medicine, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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Hall W. Commentary: The Conflict Between Protecting Public Health and Raising Tax Revenue. Healthc Policy 2024; 19:29-32. [PMID: 38721731 PMCID: PMC11131093 DOI: 10.12927/hcpol.2024.27263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
When Canada created a legal market for cannabis, it gave priority to public health by restricting marketing using branding and promotion via social and other media sources. These restrictions to protect the public from harmful use are under increasing pressure from the legal cannabis industry, which claims that they prevent them from outcompeting and replacing the illicit market. Public health advocates are reasonably concerned that these restrictions will not hold given our experience with alcohol, tobacco and gambling where governments' fiscal dependence on tax revenue favours the liberalization of regulation.
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Affiliation(s)
- Wayne Hall
- Emeritus Professor National Centre for Youth Substance Use Research University of Queensland Brisbane, Australia
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Crépault JF, Rueda S, Tang V. Five Years After Cannabis Legalization, Is It Time to Ease Restrictions on Promotion? Healthc Policy 2024; 19:21-28. [PMID: 38721730 PMCID: PMC11131094 DOI: 10.12927/hcpol.2024.27241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
In the spring of 2024, the federal government is expected to report on its legislative review of the Cannabis Act (2018). One of the most contentious issues is whether to relax restrictions on cannabis promotion. This commentary describes the tension between the public health aims of legalization and the secondary aim of displacing the illicit market. We maintain that among jurisdictions that have legalized cannabis, Canada stands out as having the stated primary objective of safeguarding public health, and its restrictions on promotion are evidence-based and innovative. These measures must be preserved, even in the face of growing industry pressure to loosen them.
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Affiliation(s)
- Jean-François Crépault
- Senior Policy Analyst Centre for Addiction and Mental Health PhD Candidate Dalla Lana School of Public Health University of Toronto, Toronto, ON
| | - Sergio Rueda
- Senior Scientist Centre for Addiction and Mental Health Associate Professor Department of Psychiatry University of Toronto, Toronto, ON
| | - Victor Tang
- Psychiatrist Centre for Addiction and Mental Health Assistant Professor Temerty Faculty of Medicine University of Toronto, Toronto, ON
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Johnstad PG. Why are the police against drug policy liberalisation? NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:568-576. [PMID: 38045009 PMCID: PMC10688397 DOI: 10.1177/14550725231185417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 12/05/2023] Open
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Doggett A, Belisario K, McDonald AJ, Ferro MA, Murphy JG, MacKillop J. Cannabis Use Frequency and Cannabis-Related Consequences in High-Risk Young Adults Across Cannabis Legalization. JAMA Netw Open 2023; 6:e2336035. [PMID: 37755827 PMCID: PMC10534274 DOI: 10.1001/jamanetworkopen.2023.36035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
Importance A key concern about recreational cannabis legalization is increases in use and adverse consequences, particularly among young adults (aged 18-29 years) who have the highest prevalence of cannabis use, and especially in higher-risk, more vulnerable young adults. However, few longitudinal studies have examined patterns of cannabis consumption in high-risk young adults over the course of legalization. Objective To examine changes in cannabis use frequency and cannabis-related consequences over recreational cannabis legalization in Canada in a longitudinal sample of high-risk young adults. Design, Setting, and Participants Longitudinal observational cohort study following young adults in Ontario, Canada, aged 19.5 to 23.0 years who reported regular heavy episodic drinking (65% past-month cannabis use) at enrollment. Participants were surveyed every 4 months for 3 years between February 2017 and February 2020 (3 prelegalization waves, 4 postlegalization waves). Data were analyzed from March to May 2023. Exposures Recreational cannabis legalization in Canada and 4 potential moderators of change: sex, income, education, and prelegalization cannabis use frequency. Main Outcomes and Measures Cannabis use frequency and cannabis-related adverse consequences. Results In a cohort of 619 high-risk young adults (baseline mean [SD] age, 21.0 [1.2] years; 346 female participants [55.9%]), omnibus model testing revealed significant overall decreases in both cannabis use frequency (F = 2.276, 3000.96; P = .03) and cannabis-related consequences (F = 10.436, 3002.21; P < .001) over time, but these changes were substantially moderated by prelegalization frequency (frequency: F = 7.5224, 3021.88; P < .001; consequences: F = 7.2424, 2986.98; P < .001). Follow-up tests showed individuals who used cannabis more frequently prelegalization significantly decreased their use and cannabis-related consequences postlegalization. In contrast, individuals who did not use cannabis prelegalization exhibited a small magnitude increase in frequency over time but nonsignificant changes in cannabis-related consequences. Sex, income, and education did not moderate changes over time. Conclusions and Relevance In this cohort study of high-risk young adults, individuals using cannabis frequently prelegalization showed significant reductions in use and consequences over time, reflecting an aging out pattern. Small increases in use among participants with no prelegalization use were observed over time, but without parallel changes in cannabis-related consequences. The results did not reveal substantive adverse near-term outcomes across the legalization period, although a within-participants design cannot rule out the possibility of alternative trajectories in the absence of legalization.
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Affiliation(s)
- Amanda Doggett
- Peter Boris Centre for Addictions Research/Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University/St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Kyla Belisario
- Peter Boris Centre for Addictions Research/Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University/St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - André J. McDonald
- Peter Boris Centre for Addictions Research/Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University/St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Mark A. Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - James G. Murphy
- Department of Psychology, The University of Memphis, Memphis, Tennessee
| | - James MacKillop
- Peter Boris Centre for Addictions Research/Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University/St. Joseph’s Healthcare, Hamilton, Ontario, Canada
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Athanassiou M, Dumais A, Zouaoui I, Potvin S. The clouded debate: A systematic review of comparative longitudinal studies examining the impact of recreational cannabis legalization on key public health outcomes. Front Psychiatry 2023; 13:1060656. [PMID: 36713920 PMCID: PMC9874703 DOI: 10.3389/fpsyt.2022.1060656] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/20/2022] [Indexed: 01/27/2023] Open
Abstract
Background Ineffective cannabis regulatory frameworks such as prohibition have sparked interest in alternative solutions to reduce individual and societal harms. While it has been suggested that the recreational legalization process has yielded early successes, the relatively recent implementation of the novel policies has provided a modest time frame for a truly thorough establishment and assessment of key population-level indicators. The following systematic review focuses on identifying the downstream public health sequelae of cannabis legalization policies, including parameters such as cannabis consumption rates, hospitalization rates, vehicular accidents and fatalities, criminal activity, and suicidal behaviors, as well as other substance use trends. Methods An exhaustive search of the MEDLINE and Google Scholar databases were performed to identify high-quality (1) longitudinal studies, which (2) compared key public health outcomes between regions which had and had not implemented recreational cannabis legalization (RML) policies, (3) using distinct databases and/or time frames. Thirty-two original research articles were retained for review. Results Adult past-month cannabis consumption (26+ years) seems to have significantly increased following RML, whereas young adult (18-26 years) and adolescent (12-17 years) populations do not show a significant rise in past-month cannabis use. RML shows preliminary trends in increasing service use (such as hospitalizations, emergency department visits, or poisonings) or vehicular traffic fatalities. Preliminary evidence suggests that RML is related to potential increases in serious/violent crimes, and heterogeneous effects on suicidal behaviors. While the research does not illustrate that RML is linked to changing consumptions patterns of cigarette, stimulant, or opioid use, alcohol use may be on the rise, and opioid prescribing patterns are shown to be significantly correlated with RML. Conclusion The current data supports the notion that RML is correlated with altered cannabis consumption in adults, potentially increased criminal activity, and a decline in opioid quantities and prescriptions provided to patients. Future work should address additional knowledge gaps for vulnerable populations, such as individuals with mental health problems or persons consuming cannabis frequently/at higher THC doses. The effects of varying legalization models should also be evaluated for their potentially differing impacts on population-level outcomes.
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Affiliation(s)
- Maria Athanassiou
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Alexandre Dumais
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Philippe-Pinel National Institute of Legal Psychiatry, Montreal, QC, Canada
| | - Inès Zouaoui
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
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Tassone F, Di Ciano P, Liu Y, Rueda S. On offer to Ontario consumers three years after legalization: A profile of cannabis products, cannabinoid content, plant type, and prices. Front Psychiatry 2023; 14:1111330. [PMID: 36873222 PMCID: PMC9978145 DOI: 10.3389/fpsyt.2023.1111330] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Cannabis was legalized in Canada in October 2018, regulating the production, distribution, sale, and possession of dried cannabis and cannabis oils. Additional products were legalized 1 year later, including edibles, concentrates, and topicals, with new lines of commercial products coming to market. Ontario is the most populous province in Canada and has the largest cannabis market with the highest number of in-person retail stores and the most cannabis products available online. This study aims to create a profile of products available to consumers three years after legalization by summarizing types of products, THC and CBD potency, plant type, and prices of product sub-categories. METHODS We extracted data from the website of the Ontario Cannabis Store (OCS)-the public agency overseeing the only online store and sole wholesaler to all authorized in-person stores-in the first quarter of 2022 (January 19-March 23). We used descriptive analyses to summarize the data. A total of 1,771 available products were mapped by route of administration into inhalation (smoking, vaping, and concentrates), ingestible (edibles, beverages, oils, and capsules) and topical. RESULTS Most inhalation products included ≥20%/g THC (dried flower: 94%; cartridges: 96%; resin: 100%) while ingestible products had similar proportions of THC and CBD content. Indica-dominant products tend to be more prominent in inhalation products while sativa-dominant products tend to be more prominent in ingestible products. The average sale price of cannabis was 9.30 $/g for dried flower, 5.79 $/0.1g for cartridges, 54.82 $/g for resin, 3.21 $/unit for soft chews, 1.37 $/ml for drops, 1.52 $/unit for capsules, and 39.94 $/product for topicals. DISCUSSION In summary, a wide variety of cannabis products were available to Ontarians for different routes of administration and provides numerous indica-dominant, sativa-dominant, and hybrid/blend options. The current market for inhalation products however is geared towards the commercialization of high-THC products.
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Affiliation(s)
- Felicia Tassone
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Patricia Di Ciano
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yuxin Liu
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sergio Rueda
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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